Stanley Feld M.D.,FACP,MACE
Measuring quality care in the healthcare system is out of control. My conclusion is that these measurements of hospitals and providers by Obamacare to determine medical care quality is distraction to quality medical care.
The method used is so complex that its measurements are inaccurate and the system is destined to fail.
The measurements are a distraction and costly. They end up diverting resources away from the hospitals’ and providers’ primary mission to provide quality healthcare at an affordable price.
In March 2016, the Healthcare Association of New York State (HANYS) published a report called Measure Madness. The report identified 2,100 required measurements of “quality care” imposed by the federal government and in turn the healthcare insurance industry on hospitals and physicians. The goal is to rate the quality of care given by hospitals and physicians.
Below is a graph of the various measurements:
Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on time spent per physician to enter the data into the electronic health record to keep track of newly introduced measures and create protocols to track and report them.
This report only covers 4 common specialties,and not all specialties and all hospital costs. There is no telling what it costs other hospitals and providers
HANYS report stated “
The volume of measures that exist, promulgated by lack of alignment and poor coordination, has created an environment of measure madness, “Consuming precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”
The “measurement madness” may be doing more harm than good, according to the report. It's the latest in a growing number of reports urging consolidation and standardization among the various groups that require reporting of healthcare quality and safety data.
The Electronic Medical Record is a great idea in theory. I have discussed functional Electronic Medical Records in detail previously. A reader can go to the search engine on this blog to review my criticism of the defects in the Electronic Medical Records sold to hospitals and doctors.
A major defect in EMR is hardly ever discussed. There is a massive amount of copy and pasting to complete the “documentation. The record does reflect anything about the patient’s illness or real progress. It does not provide a true reflection of the patient’s quality of care, natural history of his disease or disease improvement. It does not compare efficiency of medical care outcomes with the financial results of care.
The HANYS report listed the number of reports required for a computer program to evaluate the quality of medical care delivered. It is reflected in the crazy cartoon at the top of this blog.
Accountable care organizations: 33
The Delivery-System Reform Incentive Payment (or DSRIP) : more than 100
Private Health Plans: 546
National Quality Forum: 635
Each report has at least one sub report. One has only to recall all the agencies Obamacare has set up.
This bureaucratic scheme can never work efficiently.
HANYS urges stakeholders to do the work to fix the system.
The call for action was for providers of healthcare to jointly commit to the minimum number of measures needed to evaluate healthcare quality, align them with national, standardized, evidence-based data, and focus on efforts that target the most vital aspects of care.
Congress received tremendous pressure from hospitals because of the confusion the measurements have created.
Obamacare has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers.
If one measures the wrong things one will get the wrong answer.
Just over half of the hospitals fell within the three-star range.
A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”
Hospitals reviewed the ratings earlier this year.
Sixty U.S. senators heard the hospitals’ message. They sent a letter to CMS earlier this month urging the delay of the program. The senators warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers.
The American Hospital Association (AHA) has not been able to come up with the same conclusions as CMS, using the same data sets and methods.
“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.
On May 12 a conference call is scheduled to educate hospitals on how to analyze and interpret the data. In general, even the government has been confused about how best to interpret the data.
Ben Harder and Avery Comarow of U.S. News & World Report said in a recent article, “Different methodologies can produce different results even when the same raw data sets are used, said cent article.
“No approach to identifying outstanding medical centers is ideal—not ours or the government's or anyone else's,” the column stated.”
A case in point: none of CMS' five-star facilities made it onto U.S. News' annual Honor Roll. Ben Harder said, It is likely because the CMS does not yet adjust for socio-economic factors.
Again the Obama administration is making another costly complicated mistake that is making hospitals and providers go nuts and distract from their main mission of providing quality care at an affordable price.
If anyone thinks complete control of the healthcare system by the federal government via a single party payer system can do better than this government mishmash they should think again.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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